As I've told so many patients, this practice exists for your happiness. Fortunately, quite a few of my dear patients have rated this practice and the reviews can be found online. To make it easier to see them, for any of you who don't know us, we are posting links right here so you can be more easily directed to the various review sites. If you are one of my existing patients and you've reviewed our practice, thank you so very much for your support and for the generosity of the time it took you to write your comments. There is no advertising like word of mouth, and when it goes into cyberspace I am particularly grateful.

•Holly Barbour is a Superstar! I am a 58-year-old man. I had a facelift and my ear lobes trimmed down. Its not obvious that anything was even done, however, my friends are telling me how great I look! Dr. Barbour is a consummate professional with a very experienced team. My procedure took several hours and Dr. Barbour nor any of her team ever left my side. Unbelievable commitment and dedication to her patients. Dr. Barbour is a perfectionist. My wife is in awe that she cannot see any scaring at all. I would recommend Dr. Barbour and her entire team! 5 Stars!

• Dr. Barbour is consistently wonderful. She is extremely thorough and patient in her office visits and I was very pleased with the results of the surgery she performed. She does not pressure or rush her patients and I always feel she is totally honest and realistic.

•I cannot express in words how unbelievably thrilled I am with my results. I look beautiful, stunning and so refreshed. There is no other Dr. that I would have touch my face. Dr, Barbour is beyond skilled, professional, she goes above and beyond what any one would ever do. I wish you could see how happy I am, I am gorgeous because of her. Thank you doesn’t express my gratitude enough.

This is a common question among people who are considering a facelift. When facelifts look “bad”, it’s usually because they look like facelifts instead of a face that exists naturally. In medicine we call these problems the “stigmata” of facelifts. As an Oculofacial Plastic Surgeon, I can tell you that it’s difficult to go out to an event – or even dinner -- without seeing at least one example that almost breaks my heart.

This is because the stigmata that screams, “I’ve had a facelift!” is almost always completely avoidable. Here are the problems I see most often:

1.A facelift was performed on significantly sun-damaged skin or skin that lost its collagen for other reasons, like smoking. This shouldn’t be done for two reasons. One is that there’s a disconnect between the perceived age of the skin and the perceived age that the contour is signaling. Also, the skin can get drapey looking once any swelling subsides. Thus, even if it’s subconscious, the observer is getting a what’s-wrong-with-this-picture message and that in turn stimulates a recoil reaction (it really does – there’s plenty of research on this). Second, and let’s be clear: a facelift will not pull the wrinkles out of your skin (at least not for long) even if it looks as though it should when you pull your face back with your fingers at home in the bathroom mirror. Wrinkles are from collagen loss in the skin and no amount of pulling can restore that. Collagen can be restored by other means, but that would not include a scalpel.

2. A facelift was performed without regard to the fact that significant volume had been lost in the face. This is a good part of why that “too tight” look exists or why a facelift can look like skin sitting right over a skeleton, the “Cruella de Vil” look. This can also result from the use of some outdated techniques. Arguably worse is when too much fat was injected, and it happened to “take” and the face looks disproportionate and like a chipmunk.

3. The person flexes their neck down and there’s that weird crease running up behind the angle of their jaw that just does not occur in nature. Again, poor technique.

4. The ears look strange. This can be what we call “pixie ears” (so very not as cute as it sounds) in which the surgeon has put too much traction on the skin and not enough anchoring underneath, causing the earlobes to pull down and almost disappear as they run into the jawline. Even more common is when the ears have been set too far forward and look pasted on. And even more common is a thick flap of skin right in front of the ear instead of that little dip that occurs in nature.

5. Easily visible scars.Everybody heals a little differently, but placement of the incision lines and a great deal of care in sewing those incisions closed is crucial. With rare exceptions, incision lines should be something noticeable only with a search. Furthermore, the incisions should be placed and closed so that the person with the facelift isn’t restricted regarding their hairstyle.

I do a significant amount of “revision work” in my practice on facelifts done elsewhere, and most of these problems at the very least can be improved. I would advise that seeing someone’s work tells you a lot more than their advertising, which can be woefully misleading. Also, the core specialties that are well-trained in doing facelifts are Oculofacial Plastic (or Oculoplastic) surgeons, ENT/Facial surgeons, and general Plastic surgeons. None of these specialties has a lock on technique, talent or most importantly, outcomes. (Some surgeons want to think their specialty does, but that’s just greedy, egotistical and political.) Your surgeon should come out of one of these three core specialties, but beyond that they should have the drive to keep up with this evolving field, the ethics not to cut corners or worry about their pocketbooks more than your well-being, a passion for their work and your result, and the artistic vision to know what your best version of yourself can look like and how to get there.

1. You look in the mirror and see your mother... -This happens not to be a good thing, as far as you're concerned.

2. Your skin is in reasonably good condition, but you're getting/have gotten jowly. -Gravity and an accumulation of fat at the jowl area are usually the major culprits.

3. Your skin is in reasonably good condition, but you're getting/have gotten a saggy neck. -Gravity, an accumulation of fat under the chin and/or prominent muscle edges (the vertical bands down the center of the neck) are usually the major culprits.

4. You realize that a facelift is about the contour of your face and neck and not about pulling out wrinkles. -See #2 and #3. Notice that we didn’t mention wrinkly skin as a culprit. Wrinkles are the result of a loss of collagen and elastin in the skin. No surgery is going to put that collagen and elastin back. This is what lights and lasers are for, however the creases that result from the fat, gravity and loose muscles will be helped.

5. If you've been losing weight or are planning to lose weight, you're within 20 pounds of where you realistically think you're going to land for the long haul. -This is a slightly arbitrary number – we're all a bit different – but you certainly don't want to invest in a lift and then lose 50 pounds, because you may need another lift after that to look your best. Conversely, if you want to lose 50 pounds, but the reality is that you won't lose more than 20, you could be waiting forever.

6. You want to look refreshed and revitalized, but you're not looking to take off a specific (huge) number of years. -There are all sorts of little structural changes that take place over the years, not the least of which is that we lose about 20% of our skull volume over the course of our lives. Since on the face, every little millimeter shows (really - there's research that proves this), there is just no way that a 50 year old will ever look 20. But you no longer have to be a nymph to look absolutely gorgeous.

7. You're in generally good health and are confident that your family medical doctor would clear you for the procedure. -This eminently elective surgery doesn't happen unless you're healthy enough for it. A facelift does not qualify as a last ditch attempt to save your life, no matter how we may think of it.

8. You're moving up, moving on, starting a new page in your life, and you want to boogie into it looking your very best. -A good facelift is a real confidence-booster and should make you look just like you - the very best version of you.

9. But you realize that a facelift isn't a guarantee of The Fabulous Job, The Fabulous New Boyfriend, The Fabulous Husband -- and a Fairy Tale Life Forever and Ever. -Confidence really does start from the inside out. Cultivate your mind and your spirit as well as the body you're living in. Any modern physicist will tell you that we're all energy. Make it good and the rest follows.

10. You're willing to keep up/adopt healthy lifestyle choices and take good care of your wonderful self afterwards, so that this investment in yourself gives you years of rewards. -Enjoy!

The eternal facelift conundrum for almost everyone goes somewhat like this:

“I want to look better, even way better. I want to look in the mirror and see that I look awake and happy instead of tired and sad. I really want that change to happen, but I don’t want people to notice that I’ve had a facelift.”

If this is what you’ve thought, you have a lot of company. If you feel a little embarrassed about saying that, you have a lot of company. The good news is that you can have it both ways – and the reasons are twofold.

First, and most importantly, the facelift must look natural, but the road to natural has to be through the vision and skill of your surgeon, not just doing less. We could do nothing and get natural, but that’s not what you’re signing up for. You’re signing up for skilled surgery, artistic vision and the ethics of someone who will treat your face as if it were their own. Let’s say you’ve found that with your doctor and you get a result that makes you look more as you did in your youth. The vitality, radiance, lift and definition of your face are back, but what will people think????

Here’s the reality. Just to bring it into perspective, let’s look at a situation most of us have experienced. You go to a gathering. You wear a lovely outfit. A couple months later, a similar event is to take place with some of the same people. You agonize because while the outfit you wore to the first event is perfect and you feel fabulous in it, you’re a little embarrassed to wear the same thing again. But think of the people who were at that event. Can you remember what they wore? Chances are that unless something particularly stood out, you can’t.

For better or worse, human nature is engineered to make us a bit more self-absorbed than we’d like to admit.

Now back to the facelift. If it looks natural, most people will just subconsciously register that you look great, or they will consciously register that you look great and will ascribe it to just about anything but surgery on your face. They will think you changed your hair. (If you actually changed your hair around the time of the surgery, all the better.) They will think you lost weight, fell in love, went on a long vacation, retired, began working out, whatever. Of course there are exceptions to this, but mostly these will be people who either have had facial work done themselves and are now primed to notice these things or people who have been thinking about it and want to have some of what you got. And in the latter case they may pull you aside and ask where you had it done. In any event, the bottom line is that if it looks good, if it looks natural and if it looks like the best version of you, your face will cause endorphins to be released in those that look at you – and that’s all good.

The term “liquid facelift” refers to plumping up the face where it has lost volume by the injection of fillers. While fillers can have beautiful results when given expertly and artistically, “liquid facelift” is a term that can be misleading by suggesting surgical results without surgery.

While fillers may be used in the neck area occasionally, in the vast majority of cases the aging of the neck is due more to inelastic skin, gravity, excess fat or skin in the neck and/or the edges of neck muscles forming the “bands” that run vertically down the front of the neck.

In the case of inelastic skin, collagen and elastin in the skin have broken down. This requires rejuvenation of the skin, and neither surgery nor fillers will fix it. For the other aging changes of the neck surgical repair is almost always necessary for an optimal result.

Excess fat can be removed by several techniques and the neck can be surgically tightened so that instead of hanging down, the muscle actually serves as a suspension to hold the neck in a youthful contour. Most often, especially once a person has reached a certain point in the facial aging process, surgical repair of the neck becomes part of an overall facelift. These procedures are done in tandem to achieve harmony and the ideal proportions between the face and neck.

Lastly, with expert surgical technique and a truly artistic eye, a facelift and neck lift will look entirely natural without sacrificing any of the rejuvenation.

1.You have significant vertical “bands’ at your neck.These bands, sometimes called a “turkey wattle”, are the edges of a neck muscle (the platysma muscle). If the bands are very small, sometimes they can be kept at bay with BoTox, Pelleve or Ulthera, daily passive stretching of the neck or a combination of these; however, most of the time they require surgery to fix them definitively.

2.Your general facial shape looks as though it’s shifted from oval or heart-shaped to square over the years.This is gravity at work, and a good facelift will shift that contour change back so the fullness is through the midface and not hanging from your jawbone.

3.Your skin is in good shape and it’s the falling of the lower face and neck that’s the problem, not wrinkles.No matter what misleading advertisements you may have seen, a facelift is not going to change your skin texture, at least not after the initial swelling has gone away. That’s what lights and lasers are for – shrinking and resurfacing the skin – and rebuilding collagen and elastin. Wrinkles occur from DNA changes in the skin along with breaking down of the collagen and elastin. Surgery with a scalpel won’t change the skin. A lift is exactly that – it will pick up what has fallen down, but it won’t alter the make-up of your skin.

4.When you cup your hands under your chin (so the wrists meet), place your fingers on the sides of you face and then lift up gently, you look much better. Don’t worry about the wrinkles you push into being at the sides of your eyes. You’re pushing; a facelift is shaped from the inside out and nothing is pushed, so unless your skin has lost its elasticity (see above), a well-performed lift won’t leave you with more wrinkles there than you had before the lift (although a bad one certainly can).

5.Generally, you’re at least 45 years old, and more likely over 50.Nothing is without exceptions, and genetics and lifestyle choices can always throw off the norms. That said, I’ve seen way too many women in their early 40’s (one was even 36!) who had been advised by plastic surgeons that they needed facelifts when all that was going on was some volume loss. On the other hand, I’ve seen a lot of women long past their forties who really needed facelifts, but they had been pumped up with fillers until they looked stuffed. (See my blog, Jowls: Facelift or Fillers?)

If you think you might benefit from a facelift, look at these five indications and then have an evaluation by someone with the skill, the artistic vision and the integrity to advise you properly and make you your most beautiful. Click here to contact us for an evaluation appointment.

Bring us a photo of anything you’ve mothered – a child, a pet, a plant, your own parents – and we’ll honor you with a FREE ($150 value) IPL treatment for your busy hands when you purchase a full face IPL treatment.

IPL (Intense Pulsed Light) is the ideal way to eliminate age spots and small red blood vessels from anywhere on the body and get smoother, silkier skin as a side effect!

Call us today at 941.951.2220 and get your very own Mother’s Day treat, from now until the end of May!

There is a growing number of quantum physicists who theorize that thoughts actually may have mass, and there are corollaries called "field theory" and "morphogenic fields" postulating that thoughts may have a physical effect on us and our world. Additionally, there is a striking collection of experiments and anecdotal reports that support these theories. What can we take away from that in our talk about aging? We can at least suspect that a positive attitude, treating others the way we would want others to treat us, an outlook of cooperation rather than competition, and well-developed senses of compassion and empathy may very well contribute to our own well-being. Indeed, I have seen over and over throughout the past two decades of my career that people who are kind, honest and concerned as much about the well-being of others as themselves seem to stay younger in body and mind versus people who "have an edge". There's a lightness and a centeredness about them that surely contributes to that perception of youth and vitality.

There is a rich cornucopia of books out there on these subjects to suit every personality and taste. Gregg Braden's "The Divine Matrix" is a great place to start. A former aerospace computer systems designer, his writing never proselytizes but presents the reader with a feast of ideas to contemplate regarding just who we are.

An excellent way to bring your mind to a peaceful place is to meditate. My patients have sometimes said, "Oh, I can't do that -- my mind just starts to race". It's difficult for us, especially in our modern culture (although even Tibetan monks can have the problem) to completely quiet our minds. Know that you don't need to do anything formal like sitting in a particular position and you certainly don't need to reach a "goal". Sitting quietly for a few minutes and focusing on just listening to yourself breathe can be immensely calming. "Meditation" can even be losing yourself in a beautiful piece of music or stroking a beloved pet while appreciating what animals can teach us about unconditional love. Perhaps remembering an incident in your life when you felt particularly whole or fulfilled is a good way for you to begin. Anything that calms you or makes you feel peacefully happy, even if it's just for a few minutes here and there, is therapeutic.

Neurophysiologists have demonstrated that our brains have an amazing amount of "neuroplasticity" -- that we can continue to develop our brains throughout our lifetime. If you want absolute proof, log on to Lumosity.com and start training. It's very inexpensive, a lot of fun and you can track your progress with each session.

Aging is part of living; it's what we do because we are living. Attitude is one of the few elements of our lives over which we have control. Choose to see aging as the gift of living another day or another year. Choose to see aging as an opportunity to continue to grow rather than as a decline. The body you live in is precious. Give it the exercise it craves (certainly under a physician's care if you have any health issues) and the nutrients that make it healthy. Give your mind the benefit of healthy stimulation and your soul the elixir of a positive attitude. If it takes some discipline, that discipline will reward you many times over. Now that that's all solved, we'll talk later about having a face that reflects how vital and alive you feel!

My father always said that getting older is much better than the alternative. To rephrase the sentiment, when my patients bemoan their advancing age (and this often starts in their thirties) I tell them that we all have a turn at being a particular age -- unless we don't, which is not a terrific option. One of my favorite axioms is from a good friend who opined that "old" is always 15 years older than your present age. Since my patients range in age from their mid-twenties to their mid-nineties, I can attest to the truth of that.

What most people are really concerned about are all the associations we have with aging, and usually that would be a slow decline into feebleness and drooling insensibility. The good news is that our whole paradigm around that picture has changed radically over the past few decades. There has been a shift even in the past 10 or 15 years. As I've often advised my patients, anyone who is a toddler right now may very well grow up thinking grandmothers can be a blast to spend time with -- not to mention, really hot-looking. I surely have a bunch of those in my practice and they are an inspiration to us all!

Here in Sarasota where people more often than not come to have a ball rather than to fade away as they get older, we have a perfect observatory for examining what is at work in aging fabulously versus not so fabulously. Let's start to take a look.

ATTITUDE

This is not a Pollyanna-ish thing, but acknowledging its importance is absolutely fundamental. On a physiologic level, things work a bit like this: If you routinely see the glass as half empty, not only are the endorphins ("happy" peptides that are secreted in the brain) not being secreted, but there's something else going on as well. Negative thoughts actually can place the body in a state of inflammation. This in turn causes aging of the cells in the body. Life is full of stressors for all of us. This can be anything from a careless remark that hurts to an entire range of family problems, a health issue or someone trying to destroy our life and/or our career. Remember that there are always things over which we have no control. We certainly have no control over what other people do. What we absolutely do have control over is how we respond to it. And this is where we have to be completely honest with ourselves and decide what that response is going to be. Given a perfectly normal period of anger or hurt, ultimately we have a choice between crawling under the bed and sucking our thumb, being mad at the world or dusting ourselves off and moving forward. Moving forward generally involves either attempting to rectify the situation or accepting it. Books are written on this, professionals are trained to help people with it and there is always at least someone who will be on your side. But ultimately, it's just really your call.

I remember during a particularly devastating time in my own life (I'm writing a book about it), I decided to take stock of it all. I bought one of those little journals with the blank pages. It had a muted pink linen cover with a beautiful botanical drawing on the front. This was to be my "grateful book". I began listing all the things for which I was grateful, even though I was feeling crushed by life at the time. Each entry was numbered: 1.I have a 3-digit IQ 2.I have the use of both arms 3.I have the use of both legs 4. There is a ceiling over my head 5.It is attached to a ceiling over a kitchen 6.In which there is a refrigerator 7.With food in it….You get the picture. Before I knew it, there were over a hundred items on that list. I just made it an exercise to review that list every morning. I pass this on because it was immensely helpful and so healing that it compelled one friend to say, "You're just like one of those Bozo the Clown toys. You get punched and then just pop up again." "Gee, Bozo the Clown," I replied, "I haven't had a compliment like that from a man in ages!"

That exercise was difficult at the time, but it was good medicine. More later.

As we age, our eyebrows often tend to rotate down and in a bit at their outer ends. They also may thin and start to turn gray just like the hair on our heads does. The process is so insidious that we often don’t realize what is happening and that our brows may be part of the reason we suddenly notice that we look “tired”. Here are just a few tips on keeping a youthful brow. Know that I’m speaking in generalities since every individual is unique.

One of the hallmarks of a youthful brow is contrast between the color of the brow and the skin. While we want to keep our look as soft as possible as we age (since Father Time wants us to look harder and even angry), the whole upper third of the face will look prettier if the brows are well-defined. They truly are a frame for your eyes. The conventional wisdom is that we should keep the brows close to or a bit lighter than the hair color. If your hair is very light brown, blonde or gray, this rule does not apply. If the brows look faded, try a slightly darker shade of brow color. Give yourself a good day for your eye to adjust to the new color as the immediate change may throw off your perception of how it really looks.

If the brows are thicker, they will generally look younger. Pull out an old photograph of yourself and see if your brows are thinner than they used to be. If so, thicken them up a bit with your brow color, and again give yourself some time for your eye to adjust before nixing the result.

Ideally, the outer ends of your brows should be at the top of your brow bone, not curving down over the most prominent part of the rim. If the outer ends are lower than the inner ends, try lifting your brow color toward the topmost brow hairs laterally to improve the balance.

Also ideally, the outermost tip of your brow should be along a line that extends from the nostril through the outer corner of your eye on each side. Hold a pencil along that line and see where it falls when it reaches your brow. Since the ends of the brow tend to thin as we age, they can actually look shorter than the best proportion for you if you don’t extend it a bit.

Whether it’s just a matter of improving your brows with cosmetics or a situation that may require my help, we are just a phone call away if you need me or my wonderful aesthetician, Jill.